Beyond brain chemistry: What are the root causes of addiction?

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Can your environment help hook you on drugs?

Drug addiction is a disease — a chemical dependency that arises from the way certain drugs interact with the brain. Put simply: drugs like cocaine and heroin latch onto the nerve cells of the brain, releasing pleasure-producing neurotransmitters like dopamine. Abuse becomes addiction when users continually take the drug in chase of that next high.

So goes conventional wisdom when it comes to explaining what causes drug addiction — summarized in a fact sheet from the National Institute on Drug Abuse, one of the leading proponents of the theory. A similar explanation accounts for alcoholism.

But what drives someone to turn to such drugs in the first place?

In the late 1970s, a young professor of psychology at Simon Fraser University in Vancouver decided to find out. In meetings with local heroin addicts, Bruce Alexander had heard something entirely unexpected. Far from seeing their addiction as a problem, heroin users said their addiction was better than the alternative: living out broken lives that seemed to have no path to a bright future.

At the time, drug addiction research was conducted by placing rats in Skinner boxes — constricted shoebox-like contraptions where pressing a lever would deliver an instant dose of morphine to their brains. The choice was binary: the rats could either keep pressing the lever or they could simply stop. The rats chose to continue, eventually killing themselves. The results drove the conclusion that such drugs were dangerously addictive.

Like other social scientists at the time, Alexander initially accepted the validity of such findings. But once he started to question them, he realized what little value the experiments with rats had. “They’re put into solitary confinement. They live their entire life in solitary confinement. Then they’re put into the Skinner box and you have the choice of taking heroin or not taking heroin. So what do you do? Well, you take heroin. Is that a big surprise?” Alexander said in an interview.

Could the issue perhaps be not the drug itself but the solitary confinement?

Alexander set out to prove his hypothesis. He constructed what he describes in a later article as “rat park” — a large plywood enclosure with the normal conditions in which rats, by nature social creatures, would live. The park had running wheels, climbing platforms, tin cans, and, importantly, other rats, including members of both sexes. The rats also had access to the morphine that the ones in the Skinner Boxes had. But they consumed hardly any of it.

“It soon became absolutely clear to us that the earlier Skinner box experiments did not prove that morphine was irresistible to rats. Rather, most of the consumption of rats isolated in a Skinner box was likely to be a response to isolation itself,” Alexander later recalled.

The NewBostonPost asked Dr. Emine Nalan Ward, a local expert in addiction, to comment on Alexander’s theory. Ward oversees the addiction program at the West End Clinic at Massachusetts General Hospital and also teaches psychiatry at Harvard Medical School. “Over the last couple decades, our understanding of the disease of addiction has changed. We consider addiction a chronic brain disease,” Ward responded. In a comment provided via email, she elaborated on the current science of addiction.

She noted that many individuals she sees clinically haven’t been able to stop their substance use despite many attempts to do so. “As it has been shown in research, we now know that certain regions in the brain get affected, especially those regions responsible for making decisions, judgment and will power, due to chronic substance use. The analogy we use is driving a car without brakes. Therefore, addiction should no longer be considered a moral issue or a weakness or a character defect but a chronic medical illness,” Ward wrote.

Nonetheless, there are promising treatments that are available, including medications such as buprenorphine, naltrexone, methadone, acamprosate, as well as cognitive behavioral treatment, Ward noted.

There are certain risk factors for drug addiction that do include one’s circumstances, according to Ward. Those include “early teenage use, lack of parental supervision, easy availability of substances, poor social skills and coexisting mental health problems.” She noted that the 2014 National Survey on Drug Use and Health found that 40 percent of those with a drug or alcohol addiction also suffer from some form of mental illness. “The most common mental health issues are mood and anxiety disorders such as depression, PTSD and bipolar disorder,” Ward said.

But she does not go as far as Alexander does with his overriding emphasis on social circumstances. “I have summarized the current scientific understanding of addiction and therefore I don’t have much to comment on Bruce Alexander’s research,” she concluded. “His research findings have not been replicated and are not in line with the current research.”

Alexander readily concedes that his research has not won broad acceptance, a disappointing outcome that he attributes to the way in which the field of addiction theory is splintered into so many subgroups — each convinced that its specific approach is the correct one.

But he says his findings have been validated by others. When he asked, he named four studies, stretching from 1989 to 2009.

The most recent was published in the April 2009 edition of Neuropsychopharmacology by a team of French researchers who found that environmental conditions — such as prolonged weaning in “enriched environments” with toys — reduced the “rewarding effects” of cocaine on mice. (The French researchers have actually produced a series of studies along these lines; Alexander also provided the NewBostonPost with a list of some 40 academics and researchers whom he said “actively oppose the ‘brain disease model.’”)

More broadly, the importance of social circumstances as a catalyst for addiction, has been examined in two recent well-known books in the United States. In High Price, published in 2013, Columbia University neuroscientist Carl Hart combines the results of his research with his personal story of growing up in a poverty-stricken black neighborhood in Miami to argue that drug addiction is not at the root of the despair and social breakdown that plagues neighborhoods such as his, but rather a reflection of it.

The 2010 book, Methland: The Death and Life of an American Small Town, by the St. Louis-based reporter Nick Reding, makes a similar argument set in the context of a small Iowa farming town facing a future blighted by global outsourcing.

Alexander points to a wide range of factors that contribute to someone’s social well-being, effectively minimizing the risk of an addiction developing. In an interview, he drew a portrait of someone with a well-balanced life: that person is contented, has a sense of purpose and meaning, and a stable identity and connections to friends and the world around them. “Nobody’s going to get addicted when they’re like that. Why would they? They’ve got a life,” Alexander said.

Drug addiction strikes those who don’t have their lives quite pulled together, instilling a sense of identity or purpose that would be otherwise missing, according to Alexander. That holds true not just for drug use and alcoholism but also for other forms of addiction that Alexander says should also be considered. He gives two examples — so-called shopaholics and even hedge fund traders, whom he said could be addicted to money, work, or even status and power. (An individual example of the latter would be Confessions of a Street Addict by CNBC Mad Money host Jim Cramer. “Street” in the title refers to Wall Street.)

“All of these are addictions which serve that function of filling the void of a life that hasn’t come together,” Alexander said.

In its darkest forms, addiction may not be so much an escape from a meaningless void as a self-destructive embrace of it.

In a widely circulated blog entry this past May, an anonymous blogger who identifies only as “Anne Amnesia” captured this mentality of despair and nihilism, which she said is driving the opioid epidemic currently ravaging so much of the country.

The author noted that rising opioid addiction rates appeared to mirror the suicide rate. “It’s no secret that I live right smack in the middle of all this, in the rusted-out part of the American Midwest,” the blogger wrote. “Here’s the thing: from where I live, the world has drifted away. We aren’t precarious, we’re unnecessary. The money has gone to the top. The wages have gone to the top. The recovery has gone to the top. And what’s worst of all, everybody who matters seems basically pretty okay with that.” The author titled her post the “Unnecessariat,” a neologism that ultimately plays off the communist term for the lower classes, the proletariat.

That opioid addiction and suicide rates appear to coincide came as little surprise to Ward. But she tended to frame the problem in more individual than social terms: “In addition, we know that suicide and suicidal attempts are greatly affected by substance use. It is important to realize that alcohol and drugs lower inhibitions, and individuals become more impulsive under the influence of substances. In addition, substances themselves during intoxication or withdrawal can cause severe feelings of depression, hopelessness and helplessness which increase risk of suicide,” Ward wrote.

In his 2010 book, The Globalization of Addiction: A Study in Poverty of the Spirit, Alexander calls for a broader perspective.

“The old direction is that we look at guys get addicted and we try to figure out what’s wrong with this guy. You know — what’s wrong with his personality? What’s wrong with his morality? What’s wrong with his brain? What’s wrong with his genes?” Alexander told the NewBostonPost. “We have been doing that for two hundred years. We cannot answer that question. Ultimately, what we get is this whole realm of different answers. The question we need to ask is: what’s wrong with a society in which addiction becomes uncontrollable? And that question I think we can answer.”